48-year-old male, 5'11" and 220lbs with acromegaly which is currently controlled (surgery 2011). At time of diagnosis, GH (growth hormone) was 128 and IGF-1 (insulin-like growth factor) was 1100, suspected that disease had been long standing. Echo in 2011 (before disease control) showed 4.2cm ascending aorta with no sign of dilation and CT in 2014 shows 4.3cm ascending aorta. Would this be considered an aneurysm or is it just another part of the body enlarged by acromegaly? Would follow-up be the same for a patient without a history of acromegaly?

This is a relatively straightforward situation. At 4.3cm for the ascending aorta – this is below what we would define as an aortic aneurysm. There is a slight acceptable increase over normal for acromegaly. However, at this size this is still well below the size for which we would, in anyone, consider intervention. I would suggest a regular follow-up on a yearly basis. This can be done with a CT scan or an MRI scan. If it is done with a CT scan, this can be done without contrast. I would also suggest from time to time an echocardiogram, maybe every year or every other year. Aortic valvular problems in particular are not infrequently associated with a dilated aorta.